Viktor Nagy

Influence of inhomogeneous static magnetic field-exposure on patients with erosive gastritis: a randomized, self- and placebo-controlled, double-blind, single centre, pilot study

This pilot study was devoted to the effect of static magnetic field (SMF)-exposure on erosive gastritis. The randomized, self- and placebo-controlled, double-blind, pilot study included 16 patients of the 2nd Department of Internal Medicine, Semmelweis University diagnosed with erosive gastritis. The instrumental analysis followed a qualitative (pre-intervention) assessment of the symptoms by the patient: lower heartburn (in the ventricle), upper heartburn (in the oesophagus), epigastric pain, regurgitation, bloating and dry cough. Medical diagnosis included a double-line upper panendoscopy followed by 30 min local inhomogeneous SMF-exposure intervention at the lower sternal region over the stomach with peak-to-peak magnetic induction of 3 mT and 30 mT m−1 gradient at the target site. A qualitative (post-intervention) assessment of the same symptoms closed the examination. Sham- or SMF-exposure was used in a double-blind manner. The authors succeeded in justifying the clinically and statistically significant beneficial effect of the SMF- over sham-exposure on the symptoms of erosive gastritis, the average effect of inhibition was 56% by p = 0.001, n = 42 + 96. This pilot study was aimed to encourage gastroenterologists to test local, inhomogeneous SMF-exposure on erosive gastritis patients, so this intervention may become an evidence-based alternative or complementary method in the clinical use especially in cases when conventional therapy options are contraindicated.

Klasszikus vérnyomáscsökkentők: diuretikumok

The diuretics are essential medicaments of antihypertensive therapy. They reduce blood pressure and cardiovascular events optimally. With increasing doses of thiazides and thiazide analogs do not come further powerful effect of reducing blood pressure or cardiovascular mortality and morbidity, but clearly elevate the side effects. Because of it, the minimum effective dose level and the fixed-dose combination therapy should be preferred. The use these drugs leads to especially positive outcome in elder patients, isolated systolic hypertension, heart failure, after stroke and in black population. Loop diuretics as antihypertensive therapy can be used only by renal impairment. The use of aldosterone antagonists can have a good effect not only on heart failure but also on prevention of atrial fibrillation. Furthermore, using it in a combination therapy with thiazides, it reduces the risk of hypokalemia. Therefore, the diuretic treatment in hypertension is flourishing again. Orv. Hetil., 2017, 158(11), 403-408.

P0072 URSODEOXYCHOLIC ACID ADMINISTRATION FROM THE FIRST TRIMESTER IN CASE OF A SEVERE EARLY-ONSET INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Intrahepatic cholestasis of pregnancy (ICP) usually presents in the third trimester and rarely before 25 weeks’ gestation [1]. It is characterized by pruritus, mild jaundice [2], fat malabsorption and raised maternal liver enzymes and bile acids. The overall prevalence of the disease is estimated at 1/1000 to 1/10000 pregnancies [3]. Scandinavia (2%) and Chile (4%) have the highest prevalence [2, 4]. There is no uniform agreement on the criteria for diagnosing ICP. Knox and Olans [5] assert the role of elevated liver enzymes, whereas Palma et al. [6] emphasise that the most sensitive laboratory signs are the elevated total serum bile acids.Rioseco et al. suggest that the diagnosis can be made clinically based on altered laboratory results and typical symptoms [7].

[The prevention of the hypertension related damage in type-2 diabetes: the first step of the ADVANCE trial].

ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) is a large-scale trial designed to investigate the benefits of blood pressure lowering and intensive glucose control in patients with type 2 diabetes. After a mean of 4.3 years of follow-up, 73% of those assigned to active treatment (fix combination of 4/1.25 mg perindopril/indapamide) and 74% of those assigned to control remained on randomised treatment. Compared with patients assigned to placebo, those assigned to active therapy had a mean reduction in blood pressure of 5.6/2.2 mm Hg. The relative risk of a major macrovascular or microvascular event was reduced by 9% (861 [15.5%] active vs 938 [16.8%] placebo; hazard ratio 0.91, 95% CI 0.83-1.00, p = 0.04). The fix combination of perindopril and indapamide could be the best possible protector against hypertension-related consequences for patients with type 2 diabetes mellitus.

[Advanced credit: patient enrolling and therapy initiation in the ADVANCE trial].

In the new millennium, high blood pressure and diabetes are emerging as one of the greatest threats to the health of populations worldwide. The comanagement of diabetes (hemoglobinA1c < 6.5%), and hypertension (blood pressure <130/80 Hgmm), has become central to the prevention of macro- and microvascular disease in diabetic patients. The Action in Diabetes and Vascular Disease: PreterAx and DiamicroN trial, the first large prospective multicenter randomized controlled trial, uses a factorial 2 x 2 design to determine the effects on macro- and microvascular outcomes of blood pressure lowering (with a perindopril/indapamide combination) and of intensive glucose control using a gliclazide MR based regimen.

Az indapamid hatásosságának elemzése különbözô cardiovascularis végpontok szerint - Metaanalízis

Bevezetes: Az első vonalba tartozo vernyomascsokkentőktől elvarhato, hogy csokkentsek a cardiovascularis morbiditast es mortalitast. A thiazid vizhajtok ez iranyu hatekonysagat tobb metaanalizisben leirtak. Az indapamid hatasossagat bar szamos tanulmany vizsgalja, eddig nem keszult az osszes adatot osszefoglalo elemzes. Celkitűzes: az indapamid hatasossagat vizsgalo osszes randomizalt kontrollalt vizsgalat adatainak szintezise. A tanulmanyok eredmenyeit a kulonboző cardiovascularis es biztonsagi vegpontok szerint elemezzuk. Modszer: A MEDLINE adatbazisban megkerestuk az osszes randomizalt kontrollalt indapamidvizsgalatot 1995 es 2005 kozott. Csak a kettős vak-, parhuzamos lebonyolitasu vizsgalatokat vontuk be. Az adatok metaanaliziset allando es veletlen hatasu modellekben is elvegeztuk, az eredmenyeket Mantel–Haenzel-probaval, inverz varianciaprobaval teszteltuk. Eredmenyek: 9 vizsgalat es 10 108 beteg adatait elemeztuk. 48, stroke-on atesett beteg indapamidkezelesevel megelőzhető egy ujabb stroke-esemen...